| Title: |
Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| Authors: |
Tatz, G S; Blockman, Marc; Dave, J A; Ross, I L |
| Source: |
South African Medical Journal ; page e2651 ; ISSN 2078-5135 0256-9574 |
| Publisher Information: |
South African Medical Association NPC |
| Publication Year: |
2025 |
| Description: |
We report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithium toxicity. Plasma lithium concentrations and thyroid-stimulating hormone (TSH) were taken, but results were not acted upon. One week later, he presented obtunded, severely dehydrated and in renal failure. His plasma lithium concentration was 4.3 mmol/L (toxic threshold >1.5 mmol/L) and TSH >100 mIU/L. After admission to the intensive care unit, including haemodialysis and 12 days of ventilation, he developed profound polyuria, with a peak output of 15 L/day. Amiloride with hydrochlorothiazide adequately reduced the polyuria. Management of lithium-induced NDI remains complex, and includes diuretics, which paradoxically reduce polyuria in this setting. Failure to follow up critical results led to profound morbidity, and is a crucial learning point in this case. |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| DOI: |
10.7196/samj.2025.v115i3.2651 |
| Availability: |
https://doi.org/10.7196/samj.2025.v115i3.2651; https://samajournals.co.za/index.php/samj/article/download/2651/1302 |
| Rights: |
https://creativecommons.org/licenses/by-nc/4.0 |
| Accession Number: |
edsbas.5B6AFB74 |
| Database: |
BASE |